Mark Pawsey MP Member of Parliament for Rugby www.markpawsey.org.uk / @MarkPawsey Rise & Recognition of the Private Ambulance Industry 1. INTRO Thanks for invitation to speak 2010 MP Previously ran a business, at home with business people APPG Rugby MP, Rugby game Interest in emergency services Silo approach by emergency services Ambulance - Health Dept Police Home Office Fire Dept for Communities & Local Gov Ambulances are the junction of health and emergency services. Ambulance workers have one of the most important and high-pressure jobs imaginable. The brave men and women working in them face kind of situations and pressure, every day, that most people can only imagine. They are rightly held in high esteem, and I want to begin today by thanking them: for their bravery, their service, their compassion and their professionalism. Not many people realize how many Ambulance services are provided private companies, and so any tributes must apply equally to the Ambulance & paramedic staff in the private sector. The private ambulance industry has seen significant growth in recent years, and it has seen significant improvement in status. If we go back to 2012, the situation was different. 2. Before 2012: Private Ambulance companies regarded as less than professional Before the IAA was founded, there were many private ambulance companies. But they were disconnected, and they were often portrayed as renegades, and treated with suspicion, in a system that was not welcoming enough to them. They were providing good services, but often misunderstood. Because people sometimes think a private company is just there for its own profit. But from my background in business, I know the importance of providing quality service, and of understanding need of the people and organisations you are serving. Business principles, good service, fair price, whatever economic conditions, will succeed. And that is as true of independent ambulance providers as any other sector A4 MTS
And you only need to spend time with those working members of the IAA to find out what really motivates them. On a sunny day last August, I drove to Frankley Business Park Birmingham, where I was the first MP to visit a member company of IAA when I met A4MTS last year. I was made very welcome by Karen Thompson, the General Manager, and Stephen Bennett, the Chief Ambulance Officer, who are here today. There, I saw not just new, modern ambulances, but a professional business, which offers a range of services, and provided first aid at a large number of public events. In fact, they were already fulfilling what Sir Bruce Keogh s report asked for three months later. The Keogh Report on the future of the Urgent and Emergency Services The Phase 1 report from Sir Bruce Keogh on Transforming urgent and emergency care services in England, published in November last year, called for more extensive services outside hospital, and for patients with more serious conditions to be taken to centres with the best clinical teams, expertise and equipment and that means a need for high-quality ambulance services, pioneering best practice. Of course, he was focussing on NHS providers but I think that his recommendations find their answers in the work of the IAA s 60 companies. From what I saw at A4MTS, IAA providers are more than capable of taking ambulance services forward, across the country, and moving the whole of urgent and emergency healthcare forward with them. In his report, Sir Bruce Keogh set out 4 principles for ambulance services all of which I saw met all by A4MTS: 1. Provides consistently high quality and safe care, across all seven days of the week; And I saw firsthand how much IAA providers care about quality. 2. He said a good service Is simple and guides good, informed choices by patients, their carers and clinicians; And I will mention more in a moment about how well A4 MTS in particular do this 3. Sir Bruce Keogh also said that ambulance workers must Provide access to the right care in the right place, by those with the right skills, the first time; Which is something good ambulance services pride themselves on, something which is being achieved by better cooperation between healthcare services. 4. And finally, he said a service must be efficient and effective in the delivery of care and services for patients. Which I know is at the heart of everything IAA providers do. So, now, two years on, with the IAA established, the situation is very different. 3. IAA GROWTH If private ambulance companies were the forgotten national resource in 2012, today we find a very different situation. Large Scale As Anita set out, for the first time, IAA services are now recognized at the very top. Today, private ambulance companies are: Recognized by Government, and Mark referenced the importance of better understanding at a Ministerial level.
Regulated on the same basis as NHS Ambulance Trusts; Responsible for more than 50% of all NHS hospital transfers; Set to have an important role in the reforms of emergency and urgent care services. IAA has nearly 60 CQC regulated member companies, and growing. Combined they: Employ 2,800 trained personnel; Operate more than 2,600 vehicles; Over 140 locations; Revenues of 520m, 60% of market value of 880m Largest & most important independent ambulance providers to NHS Patient transport services Emergency support at peak demand times Specialist bariatric services Medical support at public events And we are seeing a real impact at a local level. Take A4 MTSA, the company I visited: - A4 MTS has transported in excess of 1.5 million patients to and from treatment centres. - And 97% of A4 MTS patients arrived before or on time for their appointments, exceeding the government target of 95% of patients arriving within 30 minutes of their appointments. Any reputation of private Ambulance providers as renegades has been shown to be wrong. Quality We will hear later from Prof. Sir Mike Richard, from the Care Quality Commission, and CQC Qualifications have helped confirm the excellence of private ambulance companies. IAA providers are not merely complying with CQCs, but pushing standards up. Since the start of regulation in April 2011, 97% of IAA companies inspected by the CQC have been found to be treating patients well In fact, care and respect in IAA companies has been found, in some cases, to be better than the trusts. Again, let me use the example of my local service in the West Midlands, A4 MTS. Their CQC said the following: On Behaviour towards patients: CQC inspectors, in December, spoke with representatives from four services that contract with A4 MTS. One representative told them I cannot recall ever hearing one negative comment from patients, their families or our staff about them They are always very pleasant to our patients. Having met them, I wasn t at all surprised to hear that. On informing Patients of action taken: CQC spoke with two members of A4MTS staff who provided patient transport for people. The CQC report took evidence from staff which enabled them to state: This demonstrated that ambulance staff took care to provide care and support with the agreement of the person using the service. And on Patient feedback: CQC praised A4MTS saying: The provider told us about their new website that had been developed to improve feedback from people who used the service. & comments received from one person who used the service complimenting the ambulance crew on their friendly attitude. Today, The IAA is not only meeting the standard, but raising the bar and working to spread good practice stating on its website that:
The IAA pursues its objectives in formal discussions with the Association of Ambulance Chief Executives, who represent the ten ambulance trusts in England, briefing meetings with the CQC as the industry s recognized stakeholder and regular contact with all other public healthcare bodies. 4. Policy of cooperation & engagement And this cooperation and engagement, with stakeholders across the health and emergency services, is spreading this professionalism and these high standards across both sectors. The Government is working hard to improve quality recognition and regulation but ultimately this is being led by the industry. The IAA is working with Government to improve quality and it is a key and proactive player as the sector seeks to improve and evolve. CQCs The way industry has engaged with CQCs is a great example. IAA providers are not merely meeting the minimum standards. They are advocating tougher CQC regulations, in order to helping ensure that standards and best practice are raised across the board. And beyond CQCs, we now find private ambulance providers fully recognized by the public healthcare community because private ambulance providers support Monitor s value for money policies; they are the ones urging innovation in contract commissioning; and they are the ones committed to standardizing ambulance training. And the IAA is achieving change: by engaging positively with Association of Ambulance Chief Executives; by brainstorming with politicians, both allies and critics; and by urging regulators to be tougher on compliance regimes And the IAA are the ones urging regulators to close loopholes in the law to stop cowboy companies operating. And the competition and pursuit of excellence that being a private company brings, and which I know from my experience in business, is also driving down costs. On average, it costs an ambulance trust 234 for an NHS emergency ambulance attending a call, but private contractors are usually cheaper than that. Cooperation and engagement And finally, as I have touched on, far from filing the same space as NHS ambulance services IAA members are working well alongside the NHS trusts to complement services, promote healthy competition, and provide cover. IAA members are the largest and most important independent providers to the NHS:- a. taking patients home to/from hospital; b. relieving pressure away from NHS emergency services by giving expert care at events; c. supporting NHS ambulance trusts in handling 999 calls d. and providing accident & emergency cover during periods of peak demand; The work of IAA members is producing a market in which NHS and independent providers compete fairly for all types of ambulance work. 5. The Future of the Independent health and ambulance service is bright
And it is the passion and service of those in the IAA that will help drive up standards and improve best-practice across all the ambulance services. Tailored services For one final example think how it is seeking to pioneer tailored services in new areas. The IAA wants commissioners to create specialist services for: o emergency mental health o falls o and bariatric patients And I can t close without mentioning company I spent time with - A4 MTS and how they are doing this. A4 MTS own Bariatric Service provides the safe and dignified solution for transporting those whose weight or condition require specialist transport. Too often, organisations are limited by the vehicles and equipment available to them and are unable to serve bariatric patients to the same standards of comfort and safety that they aspire. Once again, it is an IAA company who has best practice. People may be wary of the changes occurring in the makeup of the country s ambulance services now but in years to come we ll wonder what the fuss was about. At a time when standards are rising, when we are taking ambulance services to a new level of innovation, IAA services will be leaders - and the IAA services will become a recognized, national institution. 6. Conclusion So, looking back to where thing were in 2012, and looking forward to the opportunities ahead, private ambulance services have grown significantly, and have arrived at the centre of public healthcare at just the right time: as we are seeking to create a truly modern urgent and emergency service sector. And as an MP who has been involved in issues around this sector it is exciting to see the IAA doing exactly the right things: working with the Government and NHS to create healthy competition, and valuable cooperation and that can only be good for the service and the whole country. May I wish you a very successful conference.